Date Published: May 31, 2019
Publisher: Public Library of Science
Author(s): Philipp Schindler, Anne Helfen, Moritz Wildgruber, Walter Heindel, Christoph Schülke, Max Masthoff, Yan Li.
The aim of the study was to evaluate the feasibility of intraosseous (i.o.) contrast media injection (CMI) for emergency computed tomography (CT) of severe trauma and the associated image quality compared to intravenous (i.v.) CMI.
The authors retrospectively analysed objective (contrast-to-noise ratio (CNR)) and subjective (4-point Likert scale) image quality of CTs after i.o. (n = 4, mean age (y) 57.0±11.0) versus i.v. (n = 20, mean age (y) 58.8±4.4) CMI. All patients underwent a native head CT scan, a cerebral CT angiography (CTA) and CTA of the supra-aortic vasculature as well as a chest and abdominal CT scan in the venous phase; one patient with an i.o. access additionally received a CTA of the lower limbs. Electronic patient records have been reviewed to determine i.o. access related complications.
Both groups were consistent in age, heart rate, scan parameters including the flow rate of the contrast agent, resulting in comparable radiation dose levels. The image noise and CNR had no significant difference between the two groups. Scoring the delineation of the main vessels after i.o. CMI showed no significant difference to the i.v. group. There were no CT or i.o. access related complications observed.
The i.o. access is a safe and suitable alternative for emergency CMI in CT. Using established protocols good to very good image quality can be achieved, comparable to i.v. CMI. We show for the first time, that i.o. CMI is also feasible for CTA imaging of the head and neck region as well as of pelvic and leg vessels.
Severe trauma is a global health problem and the world’s leading cause of death for patients under the age of 45 years. Rapid and comprehensive diagnosis of traumatic conditions is critical as patients who receive early computed tomography (CT) after severe trauma reveal significantly increased probability of survival. Therefore, vascular access is of high priority and not only needed for treatment of severely injured patients but also for applying contrast agents enabling for dedicated trauma CT imaging[3,4]. Some patients do not permit rapid peripheral intravenous (i.v.) cannulation (e.g. centralization, obesity). In the case of failed i.v. placement, intraosseous (i.o.) access catheters offer an alternative for drug and volume administration[4,5].
All examinations were performed without any CT or i.o. access related complications during the scan or in the further inpatient course. Details on patients’ characteristics are shown in Table 1. There was no significant difference in age and heart rate between the two groups during the CT scan. Using identical examination protocols as well as contrast agent volumes and flow rates as described above comparable dose levels were observed.
We explored the feasibility of i.o. CMI in emergency CT in trauma management and compared the image quality to i.v. contrast enhanced CT.